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Compassion Fatigue and Burnout in Healthcare Providers Caring for Patients With Cancer

  • Authors: Linda Emanuel, MD, PhD; Frank D. Ferris, MD, FAAPHM; Charles F. von Gunten, MD, PhD; Jaime H. Von Roenn, MD
  • CME/CE Released: 12/6/2011
  • Valid for credit through: 12/6/2012
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Target Audience and Goal Statement

This activity is intended for physicians, nurse practitioners, and physician assistants (particularly those working in the field of oncology, family medicine, general medicine, and geriatrics) in either community or hospital settings, training program directors (particularly of oncology fellowships, palliative medicine fellowships, geriatric fellowships, and family practice residencies), oncology nurses, oncology social workers, palliative care nurses, and therapists treating patients with cancer.

Healthcare providers caring for persons with cancer will learn how to prevent, recognize, and deal with compassion fatigue and burnout in themselves.

Upon completion of this activity, participants will be able to:

  1. Define burnout and compassion fatigue
  2. Recognize associated signs, symptoms, and risk factors
  3. Describe a model for organizational antecedents
  4. Contrast burnout, compassion fatigue, and depression
  5. Identify techniques to decrease burnout and compassion fatigue


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Linda Emanuel, MD, PhD

    Author, researcher, educator, previously practicing clinician; Principal, The EPEC Project; Director, Buehler Center on Aging, Heath and Society (where the EPEC Project and its derivatives are housed), Northwestern University Feinberg School of Medicine, Chicago, Illinois


    Disclosure: Linda Emanuel, MD, PhD, has disclosed no relevant financial relationships.

    Dr. Emanuel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

    Dr. Emanuel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

  • Frank D. Ferris, MD

    Director, International Programs, Institute for Palliative Medicine at San Diego Hospice, San Diego, California; Professor, Department of Family and Preventative Medicine, University of California School of Medicine, San Diego, California; Co-principal, The EPEC Project


    Disclosure: Frank D. Ferris, MD, FAAPHM, has disclosed no relevant financial relationships.

    Dr. Ferris does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the US Food and Drug Administration (FDA) for use in the United States.

    Dr. Ferris does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

  • Charles F. von Gunten, MD, PhD

    Medical Director, Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California; Associate Clinical Professor, University of California, San Diego, School of Medicine; Co-principal, The EPEC Project; Past Chairman, The American Board of Hospice and Palliative Medicine


    Disclosure: Charles F. von Gunten, MD, PhD, has disclosed no relevant financial relationships.

    Dr. von Gunten does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

    Dr. von Gunten does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

  • Jaime H. Von Roenn, MD

    Medical Director, Palliative Care and Home Hospice Program, Northwestern Memorial Hospital, Chicago, Illinois; Professor of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Co-Principal, The EPEC Project; Editor, EPEC-O Curriculum; Editor-in-Chief, The Journal of Supportive Oncology


    Disclosure: Jamie H. Von Roenn, MD, has disclosed the following relevant financial relationships:
    Served as a director, officer, partner, employee, advisor, consultant, or trustee for: GTx; AstraZeneca
    Received income in an amount equal to or greater than $250 from: GTx; AstraZeneca


  • Cheryl Arenella, MD, MPH

    Cancer Education Program Specialist, Contractor, National Cancer Institute, Office of Communications and Education, Office of Education and Special Initiatives, Rockville, Maryland


    Disclosure: Cheryl Arenella, MD, MPH, has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

CNE Reviewer

  • Laurie Scudder, DNP, NP

    Nurse Planner, Medscape, LLC


    Disclosure: Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.

Nurse Planner

  • Susan B. Yox, RN, EdD

    Director, Editorial Content; Editor, Medscape Infectious Diseases


    Disclosure: Susan B. Yox, RN, EdD, has disclosed no relevant financial relationships.

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Compassion Fatigue and Burnout in Healthcare Providers Caring for Patients With Cancer: How Common Are Burnout and Compassion Fatigue?


How Common Are Burnout and Compassion Fatigue?

Several review articles have examined the literature related to compassion fatigue, caregiver stress, and burnout in health professionals caring for patients with cancer. The evidence suggests that prevalence rates for burnout, psychosocial distress, and compassion fatigue are high among oncology physicians and nurses, oncology social workers, hospice nurses, palliative care physicians, and allied health professionals working with cancer patients. Findings are similar in several countries, including Great Britain, Canada, and the United States.[7-9]

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In a large study of stress among oncologists, 56% of subscribers to the Journal of Clinical Oncology reported experiencing burnout in their professional lives.[10] Burnout was measured using an investigator-constructed questionnaire, as opposed to the Maslach Burnout Inventory, which is typically used to measure burnout.[11] When asked to define the specific nature of their burnout, 56% of respondents mentioned frustration or a sense of failure; 34% cited depression; 20% said disinterest in practice; and 18% blamed boredom. Almost 50% believed that burnout was inherent to the practice of oncology. Institution- or university-based oncologists on salary reported a lower incidence of burnout (47%) than those in private adult oncology practice (63%).

Still other studies by Graham and Ramirez have found prevalence rates on 3 dimensions of burnout from 13% to 38%, with an estimated prevalence of psychiatric diagnoses among oncologists of 28%.[12]

Another study of 395 head and neck surgeons, also using an investigator-constructed questionnaire, found that 34% of respondents reported feeling burned out, 27% indicated frustration with disease, 67% indicated frustration with government, and 58% indicated frustration with the economics of medical practice.[13]

In the United Kingdom, the percentage of clinicians reporting high levels of exhaustion on the Maslach Burnout Inventory was similar to that of the normative sample (31% vs 33%, respectively).[14,15] Among both the cancer clinicians and the normative sample, 33% reported a sense of low personal accomplishment. Significantly fewer of the UK cancer clinicians reported high levels of depersonalization compared with the US sample (23% vs 33%, respectively). In general, North Americans reported higher levels of burnout than did Europeans.[1]

In a study by Cancer Care Ontario, the comparable figure for physician exhaustion was 53.3%; for allied health professionals, 37.1%; and for support staff, 30.5%. Almost half (49%) of physicians reported having low feelings of personal accomplishment, as did 54% of allied health professionals and 31.4% of support staff.[16] The feelings of depersonalization in the Canadian group were similar to those of the UK sample, with 22.1% of physicians (vs 4.3% of allied health personnel and 5.5% of support staff) reporting feelings of depersonalization. These figures may be unique to Ontario, or may indicate an increase in stress in oncology partly as a result of ever-increasing workloads and limited resources.

A study of oncologists, housestaff, and oncology nurses from Memorial-Sloan Kettering Cancer Center reported that housestaff experienced the most burnout, emotional exhaustion, feeling of emotional distance from patients, and a poorer sense of personal accomplishment.[17] Nurses reported more physical symptoms than housestaff or oncologists; however, they were less emotionally distant from patients.

Potter and coworkers[19] investigated the prevalence of compassion fatigue and burnout among oncology nurses, using the Professional Quality of Life Revised, version IV (ProQOL R-IV) scale, a commonly used instrument for measuring the positive and negative effects of working with people who have experienced extremely stressful events [20]. It consists of 3 subscales, measuring compassion satisfaction, compassion fatigue, and burnout. Among the 153 respondents (mostly registered nurses [RNs]), staff working on inpatient nursing units had the highest percentage of high-risk compassion satisfaction scores. High-risk scores for compassion fatigue were equal among inpatient and outpatient staff (37% and 35% respectively); but 44% of inpatient staff (vs 33% of outpatient staff, a non-significant difference) were at high risk for burnout. Other studies of oncology nurses found between 37% and 47% reporting high emotional exhaustion, 11%-47% reporting high depersonalization, and 20%-55% experiencing low personal accomplishment.

Simon[21] examined the prevalence of secondary traumatic stress among oncology social workers, and found that they experienced compassion fatigue and burnout, which was inversely related to compassion satisfaction and that empathy was compromised by compassion fatigue.

Some studies[22-24] seem to indicate that hospice and palliative care physicians and nurses fare better than their oncology associates when it comes to compassion fatigue and burnout, whereas other studies dispute this. In studying hospice nurses, Abendroth and Flannery[25] found 80% to be at moderate to high risk for compassion fatigue.

Taken together, these studies illustrate that healthcare providers caring for persons with cancer (physicians, nurses, social workers, and others), experience significant rates of compassion fatigue and burnout.

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